Many articles about diabetes appear daily, many of them very interesting. The intent here is to make some of these available for others who may not see them or have bypassed them. I will try to comment briefly on those I have grouped or on an individual article. This is not guaranteed to be a daily post, but I hope that this will give you ideas for your own research or blog posts. Please talk to your doctor about medical problems.

10 June 2013

Healthcare and Research Ethics Need Improvement P1

Part 1 of 2 parts

An article appearing in several sources
on January 11, 2013 is the basis for what I am writing about. I have
succeeded in acquiring the full text of the report and the
editorials, but like the correspondent stated, it is very dense and
packed with information. I am interested in the premise of thearticle and what effect it may have on diabetes and diabetes care.
Redefining healthcare and research ethics could or should be applied
to diabetes. What the American Diabetes Association and its related
groups are doing for people with diabetes is more unethical than many
people are willing to admit.

With the John Hopkins bioethicists
making the call, this should have more weight behind this and in
reading the information available to the public, this is a discussion
with merit. As a patient, this is intriguing for me and sounds like
something that needs doing. With the poor research the last few
years that has not given clinicians any basis for changing
procedures, this may be the avenue to greater innovation by the
doctors in the trenches.

I believe that digitizing medical
information is driving this change and this is good because maybe for
once, we will not be chasing technology to get ahead in legal and
ethical standards. This is needed for the medical field to help
drive technology that is needed in so many ways. When a doctor is
faced with something completely new to him/her, being able to query
medical records from around the country and someday maybe around the
world, may lead to a quicker diagnosis of something that is still in
its infancy. A listing of symptoms and the ability to query medical
data bases may lead to teleconferences with two or more doctors that
have experienced this before and this ability may enhance diagnosis
and result in earlier treatment which is often needed.

I am fascinated that the procedures
presently used for medical research are being challenged and with
justification. In selecting study participants, most often the
patients think they are being treated when in fact they are the ones
on placebos and do not receive any benefits from the study. Yes,
some are receiving treatments, but not necessarily the correct amount
of treatment. “The authors challenge the
assumption that participation in clinical research by definition
offers patients less potential benefits and puts them at greater
overall risk than clinical practice, as well as the assumption that
research imposes more irrelevant burdens on patients.”

In the current healthcare system, over
50 percent of medical treatments are used without sufficient proof of
effectiveness, leading to 100,000 deaths annually from healthcare
acquired infections. This means that the labels of “research”
and “practice” are terms that should be our central moral
concerns and no longer serve as effective guidelines for what
requires ethical scrutiny.

For clarity, I am quoting two
paragraphs, "Far too often, doctors do
their best but simply don't have the information to tell them which
approaches or treatments work best, and patients are suffering for
that lack of knowledge," says Nancy E. Kass, deputy director for
public health at the Johns Hopkins Berman Institute of Bioethics, and
lead author of the article. "We're finding that patients are
both underprotected from risks in medical treatment and
over-protected from low-risk quality-improvement research, bringing
progress to a dangerous stalemate that is costing lives," the
authors write.

Instead, the
authors say that healthcare should be moving toward a system in which
clinical research and clinical practice are integrated, and every
clinical encounter is simultaneously an opportunity to provide needed
care to patients and also to learn from that to improve the care
provided to future patients.”

This is great and needs to be put into
practice. I do have to question how they will be able to get all
doctors on board. There are just too many doctors that think they
are all the patient needs and are more interested in the afternoon
golf game or what race is being run at the local track. Will they
take the time to rethink and relearn their profession if they are put
center stage when clinical research and clinical practice are
integrated? For some reason, I don't see this happening for these
doctors. They want others doing all the research and handing it to
them to put in practice or showing them how it works in practice.
They have little interest in research unless it makes them into more
all-knowing people than they perceive they already are.

Then on the other side, there will be
doctors that will welcome research/practice integration to be able to
continue to defraud their patients and payers, and hide it in the
name of research. As much as I may dislike the previous doctors,
these doctors are the “rotten apples” of the medical profession
and very difficult to put out of the profession.

One of these research/clinical
integrations developed for a doctor and she covers what has happened
to her idea to date. While it may not fit what most would be
thinking, this is what many doctors do not realize and are afraid to
speak out about. This problem is selecting a suitable antibiotic for
empiric treatment of UTI (urinary track infections) and knowing what
the local clinicians are finding for drug resistance preventing rapid
clearing. Does this doctor have this information yet – no, but it
sounds hopeful that it may be forthcoming in the future.

This doctor was correct in her thinking
that this information should be available to clinicians and that it
was not necessary to use patients names, but just the statistics of
what antibiotics were having problems clearing UTI in the area she
was located. Some UTI strains are more resistant than others to
certain antibiotics. I applaud this doctor for thinking outside the
box and attempting to help a patient by discovering which antibiotics
were not as efficient with the current strain of UTI.

About Me

I am enjoying life, despite diabetes type 2. I am retired and enjoying the time I have for writing and photography. I was diagnosed with type 2 on Oct 2003, on oral meds for 4 months and they were doing nothing to really improve my daily readings. By cutting my carbohydrates I received the most improvement, but still not enough. Then I requested insulin, even though I did not like the thought of needles. That brought about the biggest change and A1c's in the lower 6's and upper 5's. Now I am working at maintaining them under 6.0 and hopefully nearer 5.5.